A six-week cognitive behavioural programme, followed by four periodic refresher sessions can help alleviate fatigue for people with multiple sclerosis (MS) for at least twelve months, new research in France has found.
This programme can be delivered by a range of healthcare professionals and be easily implemented in national health systems.
In 2010, a team from Bournemouth University developed the FACETS programme. This consists of six once-weekly group sessions where people learn lifestyle tips and ways of maximising their available energy, along with helpful ways of thinking about fatigue. A clinical trial in 2013 demonstrated its effectiveness in improving people’s fatigue levels. It has since been implemented globally, including in Norway and Australia.
This new French clinical trial, published in the Journal of Neurology, Neurosurgery and Psychiatry, built on feedback from FACETS’ participants that they would like ‘booster’ sessions to be available at the end of the programme to help them to sustain momentum. Booster sessions have been used successfully in programmes for other long-term conditions.
Dr Sarah Thomas from Bournemouth University’s Clinical Research Unit led the development of the original FACETS programme and was involved in the new trial, led by CHIPS Site Hospitalier de Poissy in France.
“Fatigue is a huge issue for people with MS. It’s highly debilitating and been shown to play a key role in determining quality of life. It’s the main reason why people with MS stop working early or reduce their hours,” Dr Thomas explained.
“As it’s an invisible symptom that can vary from one day to the next or even throughout the day, it’s incredibly frustrating and challenging and can be difficult for others to understand,” she added.
In the clinical trial, 105 people with relapsing-remitting MS were randomly allocated to receive either the original manualised FACETS group programme plus standard care or standard care only. In addition, those allocated to FACETS were offered 4 in-person ‘booster’ group sessions in the 12 months following the 6-week programme (FACETS+). The booster sessions provided an opportunity to revisit key principles and strategies, discuss progress and challenges faced, make plans, and share experiences and successes.
Participants in both groups completed self-reported symptom questionnaires throughout the trial.
The results showed significant improvements in self-reported fatigue at up to one year for those who had received FACETS+ compared to the control group.
Professor Marie-Claire Gay, a clinical psychologist from Paris-Nanterre University, who led the development of the booster sessions, remarked, “It’s encouraging that, as hoped, the addition of booster sessions based on psychological theory helped to sustain the benefits of the original FACETS programme in the longer-term.”
Dr Olivier Heinzlef, a neurologist at CHIPS Site Hospitalier de Poissy, with clinical oversight of the trial, commented, “In France MS patients often receive little or no support for fatigue, so a programme like FACETS+ that can be easily implemented in current practice addresses a huge unmet need.”
Dr Thomas added, “It’s fantastic not only to see the success of the booster sessions but the transfer of the programme to a French healthcare context.”
The FACETs programme is being developed further to increase its capacity to be delivered digitally. FACETS ‘homework’ tasks are currently undertaken in a paper form and include keeping an activity diary, creating sleep and rest routines, identifying and challenging unhelpful thoughts related to fatigue, and setting fatigue management and lifestyle goals.
Dr Sarah Thomas and Professor Huseyin Dogan have recently received funding from Multiple Sclerosis Research Treatment and Education (MSRTE) charity to undertake further development and evaluation of a mobile app that gives people the option to complete these tasks on their mobile phone.